CEYLON J. MED. SCI. (D) Vol. XIV No. 1, (August 1965) SCIENTIFIC MEDICINE* by W. A. E. KARUNARATNE PART I THE DAWN The Renaissance or age of reformation has been compared to a tree which puts forth fresh buds and blossoms in springtime while the withered leaves of the previous autumn still hang thick upon its branches, and the image may very fairly be applied to the changes which then took place in the healing .art. Withington : Medical History from the earliest times. I have selected for my address an interesting phase of medical history: the first ap­ pearance of modern scientific medicine and its early developments, covering roughly, the period 1500—1700. Actually it is one aspect or phase of a movement of tremendous power and vast significance: the Renaissance. The age of the Renaissance was the transitional period between an old order of tilings and a new. between the medieval period and the modern. It ushered in a new era in practically every sphere of human thought, human activity and human endeavour. It inspired men to embark on perilous adventures which, because they were conducted not only with courage but also with intelligence, led to the discovery of new sea-routes and a new continent. It witnessed such epoch-making inventions as the printing press, the telescope and the microscope. In the vast domain of the physical sciences it signalized the appearance of new principles and new methods that were destined to change the face of the world. It saw the birth of a new art in its many aspects, plastic, pictorial, architectural, etc.. and of a new literature as rich and varied as it was bold in conception. Above all, in that age and under the influence of that movement, human thought was emancipated from the thraldom of a false conception of authority and men came vividly to realize the tremendous potentialities latent in that masterpiece of God's creation, the human intellect. It was an age of new births, of new life, of new ideas, of now hopes for the future, an age which gave to the world a now type of man and which revealed to men a new and more wonderful universe. It was truly an awakening in every department of knowledge and along every line of study. The invention of printing hastened the dissemination of the New Knowledge. I must, however, confine myself to what the Renaissance did, in parti­ cular, for the advancement of the science and art of medicine. My main task is to set before you some of the glories and splendours of the first ap­ pearance of modern scientific medicine. Before I do so, I feel I should answer certain preliminary questions. How is it that scientific medicine was so late in making its appear­ ance ? What led to the transformation, and how was the change brought about ? *Expanded version of address on the Dawn of Scientific Medicine delivered before the Faculty of Science, University of Ceylon in 1956. THE DAWN OF MODERN SCIENTIFIC MEDICINE 11 Western Europe, as we know, first found a place on the map of the world as a part of the Roman Empire. Rome had subjugated and civilized some—though not all—of the barbaric tribes of Europe. But not even Rome could give what she herself did not possess; and Rome had no medicine as she had no science. The Romans left us a lordly literature, but to science they hardly made any original contribution. The only medical work in Latin, that of Celsus, was a magnificent compilation of Greek medicine by a scientific layman. Though not a practising physician, his work is written in elegant Latin and shows much breadth of vision and great technical knowledge. Caius referred to him as "the Latin Hippocrates." The only European country in which the sciences, including medicine, as well as the arts nourished was Greece. That little country in the south-east corner of Europe—the inheritor of the culture of Crete, the learning of Egypt and the wisdom of Chaldea—was Europe's only nursery of science, and therefore of medicine. After the subjugation of Greece by Rome, Greek culture bade fair to subdue the Roman empire. The peaceful conquest would probably have been achieved in due course had it not been for two occurrences. In 323 A.D. Emperor Constantine built a new capital for himself on the Bosphorous. Before the end of that century the Roman empire was divided into two: a Western empire with Rome as capital, and an Eastern with Constanti­ nople or Byzantium as metropolis. As time passed the cleavage between East and West became more pronounced and Greek thought, learning and language, and Greek influence became more and more confined to the Eastern sector. Frederic Harrison thus sums up the debt of modern scholarship to Byzantium : '' The peculiar indispensable service of Byzantine literature was the preservation of the language, philosophy and archaeology of Greece. It is impossible to see how our knowledge of ancient literature or civilization could have been recovered if Constantinople had not nursed through the early Middle Ages the vast accumulations of Greek learning in the schools of Alexandria, Athens and Asia Minor... if the Scholiasts had not poured out their lexicons, anecdotes and commentaries ... if indefatigable copyists had not toiled in multi­ plying the texts of ancient Greece. Pedantic, dull, blundering as they are too often, they are indispensable. We pick precious truths and knowledge out of their garrulities and stupidities, for they preserve what otherwise would have been lost forever." The Western empire on her side was in the two next ensuing centuries overrun by the barbaric tribes of the North, who threatened to sweep away not only the old empire but also eA'ery vestige of civilization as well. It was left to the Christian Church to tame the wild men, without breaking their spirit or sapping their vitality and out of the rough and uncouth material fashion a new Europe. For a time all the learning that the West possessed was confined to the monasteries and ecclesiastical establishments; but the monks and clerics used their time to good pur­ pose by copying and preserving the old writings. In this waj' the Church tried as best she might to preserve " the legacy of ancient culture in a barbaric world." Before long, how­ ever, from the 6th century at least, schools began to be opened, attached to monasteries and Bishops' houses. Learning received a great impetus in England under Alfred the Great, and in France and Germany, under Charlemagne. 12 W. A. E. KARUNARATNE Meanwhile in the East, sometime after the founding of the Byzantine empire, Nesto- rius, Bishop of Constantinople was condemned to exile for heresy. He and his followers played an important part in the propagation of the Greek tradition of medicine. When the Nestorians were expelled from Byzantium thoy moved into Syria carrying with them many manuscripts and a rich medical experience. Edessa became a second Athens. As religious persecution pushed them further East they settled in Gondisapur in Persia which became the birthplace of Arabic medicine. The Nestorians and the Jews translated Greek texts into Syriac and these were retranslated into Arabic. With the closure by Justinian of the medical schools at Athens, Gondisapur and Baghdad became important centres of Nestorian Greek Medicine. "Under the Abbasides in Baghdad," says Cawadias, "remarkable translations were made of Hellenic writings, of which the Arabian physicians gave various interpretations, without however, adding any original work... The Arabian interpretation of medicine was inferior to the purely Hellenic healing art not only because it was not original but because Greek writers taught, besides facts, a technique of reasoning and observation, whereas the art of reasoning cannot be found among Arabian physicians." With the Flight (Hijra) of Mahomet from Mecca to Medina in A.D. 622, began the amazing conquests of the Arabs. Palestine. Syria and Egypt were soon conquered. They were in possession of Alexandria in 642 and its famous library was destroyed. The Caliph Omar is said to have justified this act of vandalism on the ground that " if these works of the Greeks agree with the books of God, they are useless and need not be preserved, if they disagree, they are pernicious and ought to be destroyed". It is recorded that the volumes kept the 4000 baths of the city in fuel for six months. This legend has, however, nothing to recommend it, as Gibbons tells us that a mob of fanatics some three centuries earlier "had already been fairly thorough in their destructive zeal." It is probable that the Muslims did destroy a large number of the remaning books that contained Christian teaching. They became masters of one half of the world. A Western Caliphate was established with the head­ quarters at Cordova. "The Crescentade was invincible from the land of the Sphinx to the Gothic Kingdom of Spain." After the followers of Islam satiated their lust for conquest, they developed a great enthusiasm for learning. Lane-Poole says: 'No more astonishing movement in the history of civilization has occurred than the sudden passion of the whole Islamic world for culture." As Miller has eloquently expressed it: "The seat of learning was transferred for a time from the shadow of the Cross to the Empire of the Crescent, from the classic shores of Italy and Greece to the warlike followers of Mahomet, and the fiery descendants of Ishmael.'' The glory of Athens had passed away years before and little was left of the glory of Rome. One of the first places where Arabian medicine appeared in Europe is Salerno in South Italy.